The desire to look and feel young accelerates with increasing age. Patients who feel young seek methods of appearing more youthful; closer to how they feel.
Plastic surgeons, armed with a better understanding of the aging process, have tried to address the goal of looking our best with many new techniques. The result of this research and experience has produced a mantra of "less is more."
Our goal is not to appear different than we did when we were younger, but look as we did at an earlier time. A major understanding is that volume replacement is key to achieving a youthful appearance. We lose volume in our faces, cheeks, forehead, eyebrow, temples, and hands over time, actually beginning this process in our late teens — influenced by our genes and environment.
There are some exciting new observations from achieving volume restoration, which involves having your own fat taken from the abdomen, legs, or trunk as the filler. The fat grafts can, when placed with experience and skill, bring the face or hands back to a youthful and natural appearance. This technique remains very safe and predictable, with very few problems.
There are some exciting new observations from achieving volume restoration, which involves having your own fat taken from the abdomen, legs, or trunk as the filler.
A new recognized distinct benefit is the improvement to the skin around the fat placement. We believe that stem cells and other nutrient cells combined with such transfers actually improve the circulation to local tissue. This may not replace required skin care, but there is clearly a benefit from such treatments. Fat injections can often be performed in an office under local anesthesia, or as a minor procedure. We are observing improved hand skin texture after fat injections to the top surface of hands, an area of age giveaway.
The adage, “You can never be too thin” is still an issue. Even though a thin person may have small pockets of suitable fat in the inner thigh or knee, many patients have no such fat cells available. The goal of restoring youthful volume may also be met by the product Sculptra (poly-L-lactic acid). This FDA approved volume builder can be used for facial fill, is biodegradable and biocompatible, and helps replace lost collagen. Often a series of two to three treatments in the office with minimal downtime and bruising can take years away without a scar or surgery.
Fat injections have the added benefit of being longer lasting with improvement to surrounding skin. As with fat injections, the skill and experience of the treating physician is key in avoiding problems. Other fillers such as Juvederm or Restylane can be used, but their cost per 1 cc along with their complete disappearance in a relatively short period of time is prohibitive as a volume replacement.
There are many other products available that are not FDA approved, and their safety and efficacy has not yet been established. I continue to hear stories of doctors or skin care technicians using non-approved products in the face. This should be strongly condemned as very risky.
Take note of Priscilla Presley and recall her comments against the many injections of non-approved products (transmission oil) altering her pretty face. Some of these products can only be removed by creating scars which may not be hidden. It has been stated that “No permanent filler is safe and no safe filler is permanent."
Often a combination of fat injections and judicious use of fillers will help restore a youthful appearance. But what about loose skin? The aging process can be helped to an extent with volume. Significant skin laxity can only be helped by re-draping the lax skin and muscle; therefore surgery is needed. We still believe that “less is more."
Generally, many are comfortable proceeding with office procedures that are safe, predictable and have a quick recovery. Volume falls into this group. If the skin is significantly loose and stretched above what loss of volume created, then it would make sense that something should be done to tighten the skin as well. A patient described as an example, leather pants she had worn. They were very snug and ultimately stretched beyond wearable. Probably not wise to “fill out” the stretched pants, but tighten the material.
I have written that it is arguably unethical to suggest only using expensive fillers knowing the patient will require some level of a facelift. Many reviewers caution about non-surgical skin tightening methods that may be associated with less than visible results or resulting skin damage.
The negatives of a “major” surgery may drive the patient into lesser options that may not address their needs and goals. Keep an open mind. There are facelifts that do not require hours of anesthesia or months of recovery. Such mini-lifts are becoming more common, as they only address the specific skin and muscle laxity in question. Many take but a few hours as an outpatient, with a week or so recovery.
Any level of facelift does not stop the aging process. I agree that most muscle type lifts last between 7-10 years, but the skin will continue to stretch almost immediately after surgery in some patients with skin damage. It might be suggested to plan a “tweak” months later, often in the doctor’s office, to either add slight volume, or further tighten the newly stretched skin. Maintenance then becomes an office visit to continue to look like a younger you without the stigma of visible plastic surgery.
Continue to strive to look and feel younger. Be aware of the safe and mini methods of achieving your goals, as well as the riskier techniques and products. Stay healthy, occasionally preserve your fat bank and eat that dessert ….. doctor’s orders!
Dr. Reisman is chief of plastic surgery at St. Luke’s Episcopal Hospital and clinical professor of plastic surgery at Baylor College of Medicine.